Care N Assist Ranks No. 2498 on the 2016 Inc. 5000

NEW YORK, August 17, 2016Inc. magazine today ranked Care N Assist NO. 2498th on its 35th annual Inc. 5000, the most prestigious ranking of the nation’s fastest-growing private companies. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment— its independent small businesses.

Daniel Story, CEO of Care N Assist said, “I was thrilled when I heard we made the list. We are growing, and it is because of our commitment to having a culture of caring. Its more than kindness, it sets us apart from our competition as a company who sees our client’s passion for being able to live at home and gets to work making that possible.”

The Inc. 5000’s aggregate revenue is $200 billion, and the companies on the list collectively generated 640,000 jobs over the past three years, or about 8% of all jobs created in the entire economy during that period. Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at http://www.inc.com/inc5000/list/2016/.

“The Inc. 5000 list stands out where it really counts,” says Inc. President and Editor-In-Chief Eric Schurenberg. “It honors real achievement by a founder or a team of them. No one makes the Inc. 5000 without building something great – usually from scratch. That’s one of the hardest things to do in business, as every company founder knows. But without it, free enterprise fails.”

Care N Assist has contracts with State agencies, and has Preferred Provider agreements with the Veterans Administration, Long Term Care insurance and Auto Insurance companies. These contracts give us a broad range of services to our potential clients and a great resume.

Stacey Zsigo, RN, COO says, “We only hire people that I would be comfortable sending to my own grandmother’s home.” Our Care Connects program makes matching each client to a Home Care Aide smooth as we pay attention to our client’s values and passions along with their need for support services. This program along with our specialized trainings and in-services make us an Elite In Home Care Team.

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CPR or DNR

Every time I am in a client’s home I have to talk to them about things they don’t like to talk about. It just happens most people don’t like to talk about having to go to the hospital, or worse, dying.  So as I go about creating or reviewing their emergency procedures, I end up having to make them uncomfortable. Since I don’t like making people uncomfortable I have created my own way of asking these questions.

The most important of these questions being, “Do you have a DNR, Do Not Resuscitate, order or would you like us to do CPR, Cardio Pulmonary Resuscitation?” Most people are intimidated by such a question. They start talking about their living will or Medical Durable Power of Attorney. I usually thank them for sharing this information, note it on my tablet, then I redirect them to a simpler question.

I don’t use big words or mention what is legal or not legal without a doctor’s order. I simply ask what they would want us to do. It goes like this, “What would you want my Home Care Aide to do if you fell and were hurt?” Unfortunately, many of the people I meet have experienced falling and being hurt. This is often the reason they call Care N Assist and ask for help.

Most, are quick to say they want us to call 911, or press their Emergency Pendant. They will pull the pendant out of their shirt or show me the base unit sitting on their counter. Once in awhile I will have someone say they want their son or daughter called first.

If they haven’t thought about this question before and don’t have a firm answer, this gets the ball rolling in the right direction. If they say “call family” I know they are less likely to want aggressive treatment. If they say emphatically to “call 911” I know that they are probably going to agree with a majority of my clients who want as much help as is possible.

So I proceed with the real question, “What if something else happened? What if you stopped breathing or your heart stopped and you collapsed?” I have gotten such a variety of answers from this question. Most will tell me they want our Home Care Aide to help if they can. If they say this “Yes 911, and Yes CPR” is what I write on their Care Plan.

Having just sat through another CPR training class with our Home Care Aide’s, I’m happy to say they are ready to help if needed. As our CPR trainer, Mike Bussing, always says, ”You can give that person one more Thanksgiving or Christmas with their family.”

Some of our clients will respond, “No. I don’t want CPR,” or “I have a DNR Order.” They usually have a good reason for having this opinion. For some it is a practical reason like having osteoporosis and a small frame, which would make recovering after CPR very painful. Others choose this because of illness or they believe they have lived a full life. In this case I document in our Care Plan, “Yes 911, and No CPR.”

If this is the case, I explain how it will work. We will not perform life saving CPR, but we will have to notify the proper authorities which means calling 911. Simply put, Emergency Medical Services, EMS, will show up and will be obligated to do CPR when they arrive unless they are shown a copy of a DNR order. Having this posted on the refrigerator makes it easy to find in an emergency.

Sometimes when family members are present during the consultation, they will question their loved one’s decision regarding CPR or DNR. This can be a good thing because what my client wants or prefers should be clarified before a situation happens. I am a strong advocate for my clients’ wishes to be written in the Care Plan and ensuring it will be carried out by my Home Care Aide. Having said that, I remind the client and family that I update Care Plans every 3 months or so to give them an opportunity to discuss things further.

Last, I do have clients who want “No 911, and No CPR” documented in their Care Plan. Usually this means Hospice is involved in their care. In place of calling 911 we will call the hospice nurse. This can be a great support service since everything is planned and organized to be taken care of without fail.

I enter every house knowing I have to ask these questions. I never know what a new client will say. A few of them will surprise me. Most of them are happy to hear we have regular CPR trainings with our employees. My job is to keep things simple and document clearly what their wishes are. It will be our Home Care Aide that will be responsible to help when that time comes.

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Stuck in Park

The lady I met yesterday lived in a lake house. She was bruised from a recent fall, and spoke but would get stuck on her words. Her daughter was quick to tell me that she was not suffering from dementia, she just has difficulty getting the words out.

A three-wheeled walker sat across the room from her as she sat in a patio chair with arms on it. As I sat on the couch she quipped something about me sinking in and the couch swallowing me up. I smiled back at her without saying anything about my own battle with being able to stand and walk.

Because of her difficulty getting up and off of furniture her daughter had the entire house retrofitted. She had wheelchair and walker access to the kitchen, bathroom, and bedroom areas without any barriers. She had also planned to go shopping for lift chairs within the week.

This isn’t the first client with Parkinson’s Disease that I’ve met this month or this year. Neurological disorders like this have a tendency to feel like a prison sentence. I don’t want to be overly dramatic, but if your brain is unable to get signals to your muscles it can feel like you are stuck in park and unable to get going.

The tremors that often accompany this disease get worse with movement. The ability to swallow often grows slow and drooling can be a constant difficulty. When movement is easy you can enjoy activities, but only knowing that in a moment you may again be struggling. Falls can be frequent and unavoidable. It is important to understand it is not due to weakness. It is due to the lack of communication between the client’s thoughts and the relays that signal muscle movement. It’s like trying to put the car in drive without having the proper lubricant in the transmission. It locks up.

The medication used to treat this disease does not cure it, but should relieve the symptoms. There are several medications used by doctors to help with symptoms, but the most common treatment is with Carbodopa/Levodopa. This medication has a short half-life, or short (3-4 hour window) time acting in the brain. Once taken most people feel the effects in 15 minutes and have to plan on their next dose because they will also feel their movements slow as the medication leaves their system.  

I tell our HCA’s, to avoid hurting themselves, be very patient. Allow the client to do as much as possible on their own. Use a count before assisting with a transfer so that the client is not stiff and resistant to the movement causing you to strain.  I give them permission to start and restart each movement in order to maximize the client’s abilities.

As caregivers and nurses it is easy to run low on patience. This particular group of client’s really need us to find a way to re-fuel and take our time with everyday tasks. Their health and wellness depends on them being able to maximize their good days. So, give them what they need. Patience and kindness as they get the gears turning and work through the moments where movement seems hard.

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Who Is The Hero

When I walk into a new client’s home it can be easy for me to look around and think… “Same story, different house.” The story goes a little like this. A relatively healthy person gets sick or has an injury. They hold out as long as possible before asking for help. When their needs exceed the limits of their available volunteer support they call us (or their caregiver calls us.)

When I go to meet with the client and their caregiver, I know that I am not a very important player in their story. They will grow much closer to their Home Care Aide, HCA, than they will to me. A few of them will realize that they are talking to the company owner and appear to give me their respect for gracing their home. Others will ask questions like… “Why are you seeing clients?” I can only say, “Its what makes me happy.”

It is really not about me though. I offer my expertise. I know how to ask questions and how to solve many of their problems, but once this is done it will be other hands who will guide them and care for them in their life story.

Our Staff Coordinator will use our Care Connects system to find the appropriate HCA. Our Office Manager or Administrator will agree or disagree and call the best possible HCA in to discuss the client’s needs. An introduction will be arranged under the best circumstances and the HCA will meet the client for the first time. First impressions being what they are… we hope everything will go well and we have inserted a great supporting character into the life story of our client.

A really good HCA knows that they are also playing a supporting role in a client’s life story. A few of them think that they should be the hero, but the best HCA’s have a way of making their client’s feel like they are the main character and hero in their own story. The client’s ability to find a happy ending should be the result of calling on us to help them to rise to the challenge of this chapter in their life.

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Love To Walk

I am an amputee, and when I don’t have my prosthetic on, I am at a disadvantage. It’s hard for me to remember running races or being able to play kick ball or even stepping up a curb without stopping to adjust to the terrain. People who know me can attest to the fact that I always have my prosthetic on. I walk. I move myself every day, because I love being able to walk.

Mrs. James is a client I met almost a year ago. It broke my heart when I heard her say that she has been in a wheelchair for six years. Her life has been changed because she is not able to stand and walk more than a few steps. Her problem started after a surgery. Pain kept her from getting up and moving. Since she hasn’t walked in such a long time she has become weak and uses a wheelchair.

Lets take a walk down memory lane. When was the last time you stumbled while walking? I often hear people joke about having two left feet, or the ever popular, “did you see that crack in the side walk jump up and grab my foot?” If you hear yourself or someone else say these things frequently then its time to pay attention. Most people can use a device to make walking easier or safer. Others need more intense action.

Being able to walk is taken for granted by most of us. From the moment we take off on two legs as a toddler till we have something happen that threatens that ability. There are a few things that can be done to improve or regain the ability to walk.

The first step, is believing. It is important to get your mind made up that you will be able to improve your strength and balance. If you don’t see it happening, then it will impact your progress. It has to become so important to you, that any amount of effort, energy or pain is worth it to you.

The second step, is doing exercises that will impact your ability to walk. There are specific actions that will impact balance and posture and improve the smoothness of your movements. These actions can be assigned by your therapy staff or you can talk to us about joining a free Matter of Balance class. Our Home Care Aides can work with you to help you accomplish your goals as well.

Strength only improves when you do real work. As someone speaking from experience, walking is worth the work. Keep your head up, tighten your core muscles and swing your arms. You may not move fast enough to feel the wind in your hair, but you will go places and see the people that you love.

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Social Responsibility

Social responsibility is a red hot subject in business circles right now. The culture we live in has been demanding transparency and a feel good experience from employers.

One of the biggest motivators for me to start my own business was related to the positive experience I wanted to create for my clients and employees. I got a feel good experience creating jobs and writing payroll checks. More recently my feel good experience has been related to our philanthropic activities.

As an example, we have been making contributions to Shiawassee Respite Volunteers of Shiawassee for about eight years. Though this organization provides a similar service as ours, we see it as an investment in our goal to see people living in their home. You can find more information about their organization at www.shiarespite.org.

Other organizations we have made donation too include; local schools yearbook or athletics, Alzheimer’s Association Walk, fireworks celebrations, domestic violence shelters, community partnerships, hospital foundations, etc.

This year we are doubling our commitment to invest in local causes. We are also pushing our employees to join our volunteer program. If you walk into our offices across the state you will see our TV’s showing a slide encouraging our employees to volunteer and to report their volunteerism. I believe our greatest asset is the great big hearts our employees have.

I look forward to reporting at the end of the year more about our success as a company to give back to our community as well as being able to motivate our staff to give time and talent to improve our communities.

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Happiness and Touch

Touch is so central to our humanity that it is hard to even imagine living without it. For example, if a child is born blind, they can grow up and have a completely full and normal life. They will be cognitively normal, psychiatrically normal, and not have profound problems. However, in an environment where social touch is deprived, a child will develop terrible psychiatric problems, digestive problems and immune deficiency according to Neuroscientist David Linden.

So, how touched are you? I had a client tell me not to worry about her. She said, “I’m not lonely,” even though she lived alone. She lived on the family farm and spent most of the 30 minutes each week that I visited telling me stories of her family and the farm.

I imagine she was living off the touches she had given and received all of her life. Researchers from the University of California, Berkeley say that a hug releases a hormone called Oxytocin. This hormone is sometimes referred to as the “love hormone.” Researchers say it’s got a lot to do with aging and has reparative and anti-aging benefits.

Just to add a bit more science to the conversation, touch, as a neuroelectric impulse, is recorded in two different areas of the brain. Scientists that study pain teach that signals are found to stimulate the brain in the primary somatosensory cortex. This is where the degree of sensation is deciphered. At the same time this same signal is processed in the posterior insula creating an emotional aspect to each and every sensation.

So just imagine that someone is stroking you on the arm. If they stroke really slowly, it doesn’t feel loving. It feels like a crawling bug. It’s a repellent. And if someone strokes very quickly, it doesn’t feel loving either. There is a range of speeds in which a caress feels good. You might think the brain is programmed to make the decision of what feels good, but that’s not the case. If you actually record electrical activity from these nerve endings they send more signals for caresses that feel the best per Dr David Linden.

He goes on to say that both painful and pleasurable touches are emotional and powerful. They mark experiences that are important in life. Each memory is made important by the signals sent by touch. We record it as memory and somehow underline it as important.

For all of us, the experience of touch is intrinsically emotional. This shows in the way we talk. Common English expressions like, “I’m touched by your concern,” “That’s rough,” or “He rubs me the wrong way,” are so common we don’t realize they are references to the sense of touch. Statements like; “It’s a sticky situation,” or “That’s enough of that coarse language,” brings up emotional responses because we are wired to feel touch as more than just tactile signals.

So, what do we do when our tactile thresholds are significantly increased by age or illness? In an article “Effects of Aging On Touch” by M M Wickremaratchi states that damage to the skin and its neuro receptors can decrease the signals sent to the brain. And decreased signals are expected to be related to the lower levels of hormones that produce happiness.

Some of us may shy away from persons who are older or are ill. I would encourage the opposite. See the value of the life experiences they have and get close enough to touch them, or touch the things they care about. One thing my client cared about was a flower that she kept next to her chair. We watched it grow and blossom together. It was a touch point for her and I. A picture of the flower is still in the photos I keep.

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